9 Reasons Why a TOOTH SHOULD NOT be REMOVED
Contraindications for tooth removal
Tooth extractions are not always emergency procedures. There are only so much medical conditions which have an effect on dental procedures but for this blog, only the most important ones will be discussed. A detailed one by one review of the systems would also be written.
Even though some teeth has met the criteria of indications of extraction, some factors still contraindicate from being so. These contraindications have more weight and it is sometimes due to relative dangers when done. When this happens, controlling of present condition and minimizing the symptoms are the only ways of dealing with it. In some instances, the severity of the contraindication should be solved first before any procedure is started.
The contraindications is first classified between (1) Systemic and (2) Local. This is a general summary of those procedures if you are wondering and are worried before going to the dentist.
The systemic contraindications are the condition and state of the body that might prevent the body to heal normally. There could be a compromise in health during and after the procedure. Some examples are called uncontrolled metabolic diseases.
1. End-stage renal disease and Uncontrolled Diabetes Mellitus
Some examples are most commonly: end-stage renal disease, uncontrolled diabetes mellitus. If the diabetes is controlled, then the patient may be treated normally. Diabetes Mellitus decreases the tendency of the body to heal normally. (……..) The End stage renal disease might decrease the tendency of the immune system to take on its optimum function. This makes the patient more prone to developing infections. Prescription of antibiotics, () and certain medications should also be in utmost concern because some medications may not be metabolized properly.
2. Leukemia and Lymphoma and Blood Dyscrasias
Patients who have leukemia and lymphoma should have adequate and right levels/ functioning immune cells and platelets before proceeding with extraction. Malignancy should be stabilized first before going through any dental procedures or else, there is a tendency for infection and also bleeding.
For those patients who have blood dyscrasias such as anemia, thrombocytopenia, hemophilia should not have teeth extracted unless cleared by the hematologist. The coagulopathy has to be corrected first and an optimum amount of blood levels of platelets and several coagulating factors should be achieved. In a hospital setting, though, bleeding disorders should have transfusion of platelets or coagulation factors. Communication with the hematologist is still the best thing to do before starting any procedure (even as basic as scaling) with these patients. Some that are taking anitcoagulants such as aspirin should also be required to have CBC and PT/PTT or platelet count then referred to a hematologist for clearance.
3. Heart Conditions
Some patients have a variety of heart conditions. For these case sensitive patients, a low scale infection can potentially turn into a deadly one because of passage of infection from mouth to the heart. It is always better to have a clearance first from the attending cardiologist before proceeding with extraction.
Some patients who recently had heart surgery, myocardial infarction or has severe myocardial ischemia and angina pectoris should not have dental surgery unless it is an emergency. And if it is the case, then it should be done in a hospital setting.
For patients who have uncontrolled cardiac dysrhythmias should have dental extraction procedures deffered. Those who have malignant hypertension should not undergo oral surgical procedures due to a risk of uncontrolled hemorrhage, acute myocardial insufficiency and cerebrovascular accidents.
4. Currently Taking Medications
For patients who have pertinent medical conditions and is currently taking medications such as immunosuppressants, is undergoing chemotherapy, corticosteroids, bisphosphonates, utmost consideration for these drugs should be given. These drugs suppress the immune system and could affect the healing mechanisms of the body. Doing surgical procedures without minding these medications could lead to serious detrimental effects and most importantly, infection.
For pregnant women, there is a misconception that any kind of dental procedures should not be done. It is best to know that for the first and last trimester, dental procedures should be deferred – especially for dental surgery and radical surgical procedures. For the second trimester, however, routine oral surgical procedures can be done with careful deposition of anesthesia – not intravascularly. Anesthesia tend to pass through the placenta. Extensive surgical procedures that would require drugs should not be done until the baby has been delivered. Radiographic taking should be also cautious with the use of double lead apron if it is only an emergency procedure.
Local factors means that the surrounding structures are the ones that might be the reason for contraindication. The first and foremost is the history of radiation. When a tooth has been extracted in the area of radiation within 6months or even within a year, then it could cause OSTEEORADIONECROSIS. This is because the area is devoid of blood supply and it has less capability to heal.
In practice, some patients that are encountered could be referred by an oncologist for extraction prior to surgery or radiotherapy. When this happens, careful evaluation should be done. Generally, before starting treatment, all teeth that are indicated for extraction should be extracted. Of course this is planned with the help of radiographs, CBCT and full dental evaluations. After conclusive results, teeth that are within the area of the tumor should not be taken out, most especially if the lesion is malignant. This could cause extreme bleeding andmetastases.
3. When it is acutely infected
When a tooth has acute infection. It is always better to eliminate or takeout the source of infection. The criteria is that the infection should not be acute: patient has no signs of fever (non-toxic), patient does not have difficulty opening the mouth (trismus), patient should not have difficulty breathing (dyspnea) or swallowing (dysphagia). The surrounding area should be palpated, the area should not be indurated. If these signs are present, extraction might be difficult due to decreased access because the patient could not adequately open the mouth. There could also be a decrease in the effect of anesthesia. If this is the case, then extraction should be deferred and antibiotic treatment should be started first.
Author: Keneshia Tingson